How is it done?

During open-heart valve surgery, the doctor makes a large incision in the chest. Blood is circulated outside of the body through a machine to add oxygen to it (cardiopulmonary bypass or heart-lung machine). The heart may be cooled to slow or stop the heartbeat so that the heart is protected from damage while surgery is done to replace the valve with an artificial valve.

The artificial valve might be mechanical (made of man-made substances). Others are made out of animal tissue, often from a pig.

What To Expect After Surgery

You will recover in the hospital until you are healthy enough to go home. Depending on your overall health, you will likely go home a few days after surgery.

Surgery will likely involve a long recovery over several weeks. You will probably need to take 4 to 12 weeks off from work. It depends on the type of work you do and how you feel. In some cases, full recovery may take several months.

Why It Is Done

Aortic Valve Regurgitation

If your chronic regurgitation is getting worse and you have symptoms, you will likely have surgery. You might have surgery before you get symptoms, especially if your regurgitation is getting worse. If you have acute regurgitation, surgery will likely be done right away.

How Well It Works

Valve replacement surgery is the only cure for aortic valve regurgitation. It helps relieve symptoms and prevent heart failure. And it helps people live longer.1

Aortic Valve Stenosis

Valve replacement surgery is the only effective treatment for people who have severe aortic valve stenosis with symptoms.1 If you don't have surgery after you start having symptoms, you may die suddenly or develop heart failure. Surgery can help you have a more normal life span.

Risks

Valve replacement surgery has a high rate of success and a low risk of causing other problems if you are otherwise healthy. Although most people have successful outcomes, there is a risk of death and serious problems during surgery. Valve replacement surgery is high-risk for people who have a failing left ventricle and who have had a heart attack. About 5 or less out of 100 people who have valve surgery die.2

If you have an aortic valve regurgitation or stenosis and have symptoms, the risks of not replacing the valve are greater than the risks of surgery unless you have other health problems that make surgery too dangerous.

Even if valve replacement surgery is a success, you may have problems after surgery, such as:

An increased risk of blood clots. These can break off and cause a stroke or heart attack. You will need to take blood-thinning medicines (anticoagulants) right after surgery to help prevent blood clots. If you get a mechanical valve instead of a tissue valve, you will need to take blood-thinners for as long as you have that valve.

A need for another replacement valve. This will depend on the type of valve you get and how long you live after you have the surgery.

Incomplete relief from symptoms. Some types of valves do not have openings as wide as a normal valve for a person your size. This can limit how well the valve works to relieve your symptoms.

A valve that fails. There is a small chance that the valve will not work. Your doctor will need to check from time to time to make sure that your valve is working.

What To Think About

If you decide to have surgery, you and your doctor will decide which type of valve is right for you.

Transcatheter aortic valve replacement is a new way to replace an aortic valve. It does not require open-heart surgery. It is a minimally invasive procedure that uses catheters in blood vessels to replace the aortic valve with a specially designed artificial valve. The catheters are inserted through small cuts in the groin.

This procedure is available in a small number of hospitals. And it is not right for everyone. It might be done for a person who cannot have surgery or for a person who has a high risk of serious problems from surgery. For example, it might be an option if you are not healthy enough for an open-heart surgery. Although this procedure is minimally invasive, it has serious risks including stroke, kidney problems, and death.3

References

Citations

Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):

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